What is Information Blocking?
In the 21st Century Cures Act, The Office of the National Coordinator (ONC) for Health Information Technology (HIT) released requirements regarding the prevention of “information blocking.” Information blocking refers to anything that restricts sharing and accessing electronic health information (EHI) among physicians and patients. The benefits of the information blocking provisions:
Direct Address Requirement
Upload digital contact information in NPPES
As of
May 1, 2021, per the 2020 CMS Interoperability and Patient Access Final Rule, physicians must provide their digital contact information (direct address and/or an Application Programming Interface endpoint) in the
National Plan and Provider Enumeration System (NPPES). The direct address is similar but not the same as an email address and can be obtained from the physician's EHR vendor (ex.
B.wells@direct.aclinic.org). This information is publicly available in the
NPI registry and the
NPI downloadable file. To learn more about direct addresses, refer to the
Direct Address Q&A.
How to meet this requirement
- Refer to the CMS Public Reporting of Missing Digital Contact Information web page to determine if you are non-compliant with the requirement, or search for your name and/or NPI on the NPPES NPI lookup web page and verify in the Health Information Exchange section that your endpoint (direct address) is included. If you do not see any information in that section, most likely you are not at compliance and will need to upload your direct address.
- Obtain your direct address or API endpoint from your EHR vendor, HIE, or another certified entity with direct messaging capability, such as a Health Information Service Providers (HISPs).
- Log in to NPPES with your user ID and password and enter the direct address in the API endpoint field in the Health Information Exchange section.
Penalties
There are no penalties at this time for noncompliance. However, CMS has publicly published a list of physicians who have not complied. Penalties will be considered in future rulemaking.
Resources
Information Blocking Requirement
Information blocking is a practice by an "actor" that is likely to interfere with the access, exchange, or use of electronic health information (EHI), except as required by law or specified in an information blocking exception.
EHI is defined as the electronic protected health information (ePHI) in a designated record set (as defined in the Health Insurance Portability and Accountability Act (HIPAA) regulations) regardless of whether the records are used or maintained by or for a covered entity and includes all electronic medical information maintained by your practice or hospital. EHI shall not include psychotherapy notes as defined in
45 CFR 164.501 or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
Information is EHI if it is:
- Medical records and billing records of a provider used in whole or in part, to make decisions about individuals;
- Individually identifiable health information that is either maintained or transmitted electronically; AND
- Not excluded form the EHI definition
Information is not EHI if it is:
- Not excluded form the EHI definition
- Psychotherapy notes as defined in 45 CFR 164.501
- Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action
or proceeding
- Individually identifiable health information in education records covered by the Family Educational Rights and
Privacy Act, 20 U.S.C. 1232g
- Individually identifiable health information in records described at 20 U.S.C. 1232g(a)(4)(B)(iv)
- Individually identifiable health information in employment records held by a covered entity in its role as employer
- Individually identifiable health information regarding a person who has been deceased for more than 50 years
- De-identified protected health information as defined under 45 CFR 164.514
How to meet this requirement
The
physician is responsible for verifying with their EHR vendor their preparations for
complying with the information blocking rules. To ensure that the requirement
is met, patients should be able to access this health information
electronically without charge and without delay. To
comply, physicians and practices should:
- Check
with their EHR vendor about their capabilities to allow the release and accessibility of the required information in the patient portal.
- Ask the EHR vendor how they will help to determine and document the use of exceptions (see
“Exceptions” section below).
- Evaluate whether existing practice policies about accessing EHI reflect the ONC Final
Rule requirements and ensure that the practice staff understands how to
approach EHI requests.
Penalties
On June 24, 2024 HHS released the final rule outlining disincentives for eligible hospitals, critical access hospitals, physicians, and ACOs found to have committed information blocking. For physicians, this final rule establishes penalties that include losing Medicare participation status, public disclosure of those who have been subject to information blocking enforcement, and receiving a score of 0 in the MIPS promoting interoperability category that will likely result in the eligible clinician receiving a negative payment adjustment in the corresponding payment year. Other penalties will be levied against ACOs under the Medicare Shared Savings Program and eligible hospitals or critical access hospitals under the Medicare Promoting Interoperability Program.
This rule builds on the June 2023 final rule that established penalties for information blocking actors other than health care providers, as identified in the Cures Act. The new disincentives will go into effect 30 days after the publication of the final rule in the federal register, except for ACOs which become effective Jan. 1. HHS’s brief summary. A brief summary of this final rule can be found in the HHS press release.
Exceptions
There are eight exceptions that when the practice meets the condition(s) of an exception, it will not be considered information blocking.
Resources